Shortage Keeps Older Docs on the Job

As the nation's debate about overhauling health care heats up, one truth remains undisputed. There are not enough general care doctors to meet current needs, let alone the demands of some 46 million uninsured, who threaten to swamp the system.

Young doctors opt for specialties, fueling looming lack of primary care. At age 81, Dr. Kenneth H. Spady admits he's finally ready to retire. Almost. After nearly 53 years in practice, at least 1,500 babies and more than 260,000 office visits, the sole medical doctor in this town of 2,100 figures it's time to plan for the future. After more than two years of trying, and several close recruiting calls, there's still no one to take his place in this rural community 100 miles north of Seattle, where the nation's shortage of primary care doctors has landed squarely at Spady's office door.

It's a problem growing worse in Everson and across the country, where more aging doctors are finding they can't retire. In the U.S., there are at least 4,500 primary care doctors older than 75, according to figures from the Physicians Masterfile database maintained by the American Medical Association. Overall, there are about 270,000 doctors practicing primary care, which includes family, general medicine and internal medicine.

As younger doctors increasingly choose the better pay and balanced lifestyle promised by specialty practice, older doctors, especially in poor and rural areas, are working longer, reluctant to abandon their clients - but unable to find new care for them.

For patients, that translates into long waits, long drives, or, in worst cases, postponed care that eventually lands them in the emergency room.

If current trends continue, the U.S. will be short by about 125,000 family care doctors by 2020, according to Dr. Ted Epperly, president of the AAFP board. He estimated that the U.S. needs between 40 percent and 50 percent more family practice doctors than the nearly 100,000 working now. "The pipeline of family physicians has dried up," said Epperly, who's hopeful that health care reform will help correct the problem.

Then, there's the compensation question. The median annual wage for a family physician last year was about $190,000, according to a survey by the American Medical Group Association, a physician search firm. In contrast, a dermatologist earned nearly $345,000 and an orthopedic surgeon earned about $450,000.

The difference is driven largely by Medicare-related reimbursement rates, which pay more to doctors who perform specific procedures than to doctors who diagnose and treat general illness. Under so-called fee-for-service Medicare rates, a Boston primary care doctor received $103.42 for a half-hour office visit, but Medicare paid $449.44 for a diagnostic colonoscopy, a procedure that takes about the same time, according to a 2008 Government Accountability Office report.

Compensation becomes key at a time when the average graduate leaves medical school with student loan debts that top $141,000 and can approach $200,000, according to the Association of American Medical Colleges. Many new doctors worry it'll take decades to repay loans, experts said

The problem is especially acute in places like in rural areas, where there are barely 80 primary care doctors per 100,000 people, compared to the U.S.average of 120 per 100,000, according to a report last year by the United Health Foundation. Washington state fares better, at 124 per 100,000, though the numbers fall in rural areas like Whatcom County, which has 105 primary care doctors in a region of just under 200,000.

(Minnesota Future Work note: "The good news for Minnesota rural areas is that 78% of rural physicians practice in a primary care specialty. The bad news is that rural areas have few specialists. An estimated 84% of surgical specialists practice in metropolitan counties, while only 4% practice in the state's 46 most rural counties. Of non-surgical specialists, 91% practice in metropolitan counties and only 2% in rural counties. Primary care specialists account for 44% of practitioners in metropolitan counties." Source: http://www.mnsu.edu/ruralmn/pages/Publications/rmj/RMJ1-07/Fonkert01-07.pdf)

Source: msnbc.com, JoNel Aleccia, 6/24/09